Ocular injuries, attention deficit and hyperactivity disorder, and maternal anxiety/depression levels: Is there a link?

PURPOSE: Given the increased risk of accidents in patients with attention deficit and hyperactivity disorder (ADHD) or maternal anxiety/depression, we aimed to investigate the frequency of the two diseases in children with penetrating eye injury (PEI). METHODS: Altogether 79 children, 39 with PEIs and 40 healthy individuals (control group), aged 5-15 years, underwent a complete ophthalmologic examination. Afterwards, schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children. Turgay diagnostic and statistical manual of mental disorders (DSM-IV)-based child and adolescent behavior disorders screening and rating scale (T-DSM-IV-S) was filled by parents to evaluate the severity of ADHD symptoms. The depression and anxiety levels of mothers of each group were evaluated by two self-report measures: the Beck depression scale and the state-trait anxiety inventory (STAI), respectively. Data were analyzed by IBM SPSS version 22.0. The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables. RESULTS: The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs (48.7% in PEI vs. 17.5% in control group, χ2 = 7.359, p = 0.007). The total scores of the T-DSM-IV-S (attention subscale U = 418.000, p = 0.006; hyperactivity subscale U = 472.000, p = 0.022) and maternal state-trait anxiety inventory (maternal STAI-state U = 243.000, p = 0.003; maternal STAI-trait U = 298.000, p = 0.021) were significantly higher in the PEI group than in control group. In logistic regression, children with PEI had a tendency to have a 3.5-fold increased risk for ADHD (OR = 3.538, CI = 0.960-13.039, p = 0.058). CONCLUSION: ADHD was detected almost 1 in 2 children with PEIs. Besides, the maternal anxiety level was significantly higher in the PEI group than in the control group. This association should be further explored via a future prospective longitudinal study. Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.

Vision-related quality of life in patients after ocular penetrating injuries.

PURPOSE: To measure and investigate visual functioning and health-related quality of life (QOL) in patients after ocular penetrating injuries (OPI). METHODS: Fifty-four adult patients with OPI and 26 healthy control subjects were enrolled in the study. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and the 36-Item Short Form Health Survey (SF 36) were administered. Sociodemographic and clinical data also were collected. The primary outcome measures were comparisons and multivariate analysis among groups for the NEI VFQ-25 and SF 36 subscale scores. RESULTS: All NEI VFQ-25 scores, except general health, were significantly lower in the OPI group than those in the control group. All SF 36 scores were significantly lower in the OPI group than in the control group. The NEI VFQ-25 subscale item scores showed no significant differences with respect to age, educational level, or visual acuity in the injured eye. The SF 36 subscale item scores revealed no significant differences according to gender or educational level. CONCLUSIONS: Patients with OPI have increased psychological symptoms and lower levels of QOL than healthy control subjects have. Deteriorations in QOL should be kept in mind when managing patients with OPI.

Vision-related quality of life in patients after ocular penetrating injuries / Qualidade de vida relacionada à visão em pacientes após ferimentos oculares penetrantes

Purpose: To measure and investigate visual functioning and health-related quality of life (QOL) in patients after ocular penetrating injuries (OPI). Methods: Fifty-four adult patients with OPI and 26 healthy control subjects were enrolled in the study. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and the 36-Item Short Form Health Survey (SF 36) were administered. Sociodemographic and clinical data also were collected. The primary outcome measures were comparisons and multivariate analysis among groups for the NEI VFQ-25 and SF 36 subscale scores. Results: All NEI VFQ-25 scores, except general health, were significantly lower in the OPI group than those in the control group. All SF 36 scores were significantly lower in the OPI group than in the control group. The NEI VFQ-25 subscale item scores showed no significant differences with respect to age, educational level, or visual acuity in the injured eye. The SF 36 subscale item scores revealed no significant differences according to gender or educational level. Conclusions: Patients with OPI have increased psychological symptoms and lower levels of QOL than healthy control subjects have. Deteriorations in QOL should be kept in mind when managing patients with OPI. .

Objetivo: Medir e investigar a função visual e a qualidade de vida relacionada à saúde (QOL) em pacientes após ferimentos ocular penetrantes (OPI). Método: Cinquenta e quatro pacientes adultos com OPI e 26 indivíduos saudáveis (controles) foram incluídos no estudo. O questionário de função visual do National Eye Institute (NEI VFQ-25) e a avaliação curta de 36 itens (Short Form Health Survey - SF 36) foram administrados. Dados sociais, demográficos e clínicos também foram coletados. As comparações e análise multivariada entre os grupos para as subescalas do NEI VFQ-25 e do SF 36 foram consideradas como resultados primários. Resultados: Todos os índices do NEI VFQ-25, exceto saúde geral, foram significativamente menores no grupo OPI do que aqueles no grupo controle. Todos os índices do SF 36 foram significativamente menores no grupo OPI do que no grupo controle. Os índices das subescalas do NEI VFQ-25 não apresentaram diferenças significativas em relação à idade, escolaridade, ou acuidade visual no olho ferido. Os índices das subescalas do SF 36 não revelaram diferenças significativas de acordo com o nível de escolaridade ou sexo. Conclusões: Pacientes com OPI apresentaram sintomas psicológicos aumentados e níveis mais baixos de qualidade de vida que os indivíduos saudáveis. Deteriorações na qualidade de vida devem ser consideradas ao gerenciar pacientes com OPI. .

Bilateral oedipism.

A 20-year-old woman presented with self-inflicted pencil wounds to her bilateral orbits. CT angiography revealed penetration of pencils through optic canals into temporal lobes. Examination revealed bilateral no light perception, fixed dilated pupils, complete ptosis, and complete ophthalmoplegia. The patient was admitted to the psychiatric ward and her vision and cranial nerve deficits did not improve.

[Traumatic enucleation. Accident or self-mutilation?]. / Traumatische Enukleation. Unfall oder Selbstverletzung?

A 52-year-old woman was admitted for emergency treatment after traumatic enucleation. Because of the position of the avulsed eye and the acute mental condition of the patient a trauma caused by self-mutilation could not be excluded. There was even the suspicion of self-enucleation in a second case and in both cases a psychiatrist was consulted but ultimately a disastrous accident was clearly verified for both patients. Nevertheless, an interdisciplinary evaluation should be initiated in cases of patients with a suspicious traumatic injury as in cases of self-mutilation the danger of relapse is high in the first hours and weeks after the primary event.

Self-inflicted penetrating eye injuries using a razor blade: case report.

BACKGROUND: A 23 year old white male with a history of social and behavioural problems attempted to blind himself chemically, with alcohol, and mechanically, with a razor blade. METHODS: Observational case report of a patient who self-inflicted bilateral scleral lacerations with a razor blade, after losing his job. RESULTS: The patient sustained bilateral inferior scleral perforations, with hypotony and a right traumatic cataract. He received urgent surgical repair, and prophylactic antibiotics. There were no retinal breaks or detachments. He later underwent successful cataract surgery to the right eye. CONCLUSION: Self-inflicted ocular injury may be possible in non-psychotic patients, as a situational response to a life event. Urgent repair can completely restore vision in some cases. Referral for psychiatric counseling is mandatory.

[Partial oedipism: case report]. / Oedipism partial prezentare de caz.

We present the case of a schizophrenic patient in acute psychosis, with religious delusions, and autoaggressive acts, resulting amaurosis of the right eye and impairment of the other, and showing the difficulties of managing and therapy, as the crucial importance of the team work between the ophthalmologist, the neurologist and the psychiatrist.

Severe ocular self-injury.

To further delineate the clinical characteristics of patients who deliberately, severely mutilate their eyes, we reviewed the medical records of a specialty eye hospital and found nine cases of intentional, severe, self-inflicted eye injuries. We identified two groups of patients. Most were young psychotic individuals with severe psychopathology often involving sexual and religious delusions, command hallucinations, and the propensity to act on delusions. The second group was comprised of patients with organic disabilities, either dementia or severe mental retardation, where a lack of impulse control and preexisting eye irritation or surgical operation may have contributed to the act. One patient was a recidivist. Two-thirds of the patients were confined at the time of the act. That self-mutilation may occur frequently in confined patients calls for active vigilance from caretakers; that it may recur calls for caution by the psychiatrist.

[Implications of concomitant therapy with psychotropic drugs in emergency care. Discussion of current literature with reference to a case report]. / Bedeutung einer bestehenden Therapie mit psychotropen Pharmaka in der Notfallversorgung. Diskussion der aktuellen Literatur anhand eines Fallberichts.

This case report deals with an acute psychotic suicidal patient who stabbed two nail-scissors straight into his eyes. The extent of the trauma was unknown primarily during emergency treatment, and an intracranial trauma had to be considered. Furthermore, there was no information on the patient's history including medical therapy or abuse of psychotropic drugs like monoamine oxidase inhibitors, tri- or tetracyclic antidepressants, neuroleptic agents, or lithium salts which could have consequences for subsequent drug administration. The emergency aid management of psychotic patients with the possibility of both an intracranial trauma and an existing psychotropic drug therapy is discussed in this case report.